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Schermers B, Franke V, Rozeman EA, van de Wiel BA, Bruining A, Wouters MW, van Houdt WJ, Ten Haken B, Muller SH, Bierman C, Ruers TJM, Blank CU, van Akkooi ACJ. Surgical removal of the index node marked using magnetic seed localization to assess response to neoadjuvant immunotherapy in patients with stage III melanoma. Br J Surg 2019; 106:519-522. [PMID: 30882901 PMCID: PMC6593699 DOI: 10.1002/bjs.11168] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 01/16/2019] [Accepted: 02/12/2019] [Indexed: 12/11/2022]
Abstract
This pilot study explored the value of localized index node removal after neoadjuvant immunotherapy in patients with stage III melanoma, for use as a response indicator to guide the extent of completion lymph node dissection. Promising technology.
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Affiliation(s)
- B Schermers
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands.,MIRA Institute, University of Twente, Enschede, the Netherlands
| | - V Franke
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - E A Rozeman
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - B A van de Wiel
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - A Bruining
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - M W Wouters
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - W J van Houdt
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - B Ten Haken
- MIRA Institute, University of Twente, Enschede, the Netherlands
| | - S H Muller
- Department of Clinical Physics, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - C Bierman
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - T J M Ruers
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands.,MIRA Institute, University of Twente, Enschede, the Netherlands
| | - C U Blank
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - A C J van Akkooi
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
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van Akkooi A, Schermers B, Franke V, Wouters M, Zuur C, Klop W, Rozeman E, van de Wiel B, Ruers T, Blank C. Pilot study: Localizing target lymph node using a magnetic marker allows reliable and representative judgement of pathological responses after neo-adjuvant ipilimumab (IPI) + nivolumab (NIVO) in macroscopic stage III melanoma. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy289.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kleinloog R, Zwanenburg JJM, Schermers B, Krikken E, Ruigrok YM, Luijten PR, Visser F, Regli L, Rinkel GJE, Verweij BH. Quantification of Intracranial Aneurysm Volume Pulsation with 7T MRI. AJNR Am J Neuroradiol 2018; 39:713-719. [PMID: 29472302 DOI: 10.3174/ajnr.a5546] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 11/30/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Aneurysm volume pulsation is a potential predictor of intracranial aneurysm rupture. We evaluated whether 7T MR imaging can quantify aneurysm volume pulsation. MATERIALS AND METHODS In Stage I of the study, 10 unruptured aneurysms in 9 patients were studied using a high-resolution (0.6-mm, isotropic) 3D gradient-echo sequence with cardiac gating. Semiautomatic segmentation was used to measure aneurysm volume (in cubic millimeters) per cardiac phase. Aneurysm pulsation was defined as the relative increase in volume between the phase with the smallest volume and the phase with the largest volume. The accuracy and precision of the measured volume pulsations were addressed by digital phantom simulations and a repeat image analysis. In Stage II, the imaging protocol was optimized and 9 patients with 9 aneurysms were studied with and without administration of a contrast agent. RESULTS The mean aneurysm pulsation in Stage I was 8% ± 7% (range, 2%-27%), with a mean volume change of 15 ± 14 mm3 (range, 3-51 mm3). The mean difference in volume change for the repeat image analysis was 2 ± 6 mm3. The artifactual volume pulsations measured with the digital phantom simulations were of the same magnitude as the volume pulsations observed in the patient data, even after protocol optimization in Stage II. CONCLUSIONS Volume pulsation quantification with the current imaging protocol on 7T MR imaging is not accurate due to multiple imaging artifacts. Future studies should always include aneurysm-specific accuracy analysis.
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Affiliation(s)
- R Kleinloog
- From the Department of Neurology and Neurosurgery (R.K., B.S., E.K., Y.M.R., L.R., G.J.E.R., B.H.V.), Brain Center Rudolf Magnus
| | - J J M Zwanenburg
- Department of Radiology (J.J.M.Z., P.R.L., F.V.), Utrecht University, University Medical Center Utrecht, Utrecht, the Netherlands
| | - B Schermers
- From the Department of Neurology and Neurosurgery (R.K., B.S., E.K., Y.M.R., L.R., G.J.E.R., B.H.V.), Brain Center Rudolf Magnus.,Department of Technical Medicine (B.S., E.K.), Faculty of Science and Technology, University of Twente, Enschede, the Netherlands
| | - E Krikken
- From the Department of Neurology and Neurosurgery (R.K., B.S., E.K., Y.M.R., L.R., G.J.E.R., B.H.V.), Brain Center Rudolf Magnus.,Department of Technical Medicine (B.S., E.K.), Faculty of Science and Technology, University of Twente, Enschede, the Netherlands
| | - Y M Ruigrok
- From the Department of Neurology and Neurosurgery (R.K., B.S., E.K., Y.M.R., L.R., G.J.E.R., B.H.V.), Brain Center Rudolf Magnus
| | - P R Luijten
- Department of Radiology (J.J.M.Z., P.R.L., F.V.), Utrecht University, University Medical Center Utrecht, Utrecht, the Netherlands
| | - F Visser
- Department of Radiology (J.J.M.Z., P.R.L., F.V.), Utrecht University, University Medical Center Utrecht, Utrecht, the Netherlands.,Philips Healthcare (F.V.), Best, the Netherlands
| | - L Regli
- From the Department of Neurology and Neurosurgery (R.K., B.S., E.K., Y.M.R., L.R., G.J.E.R., B.H.V.), Brain Center Rudolf Magnus.,Department of Neurosurgery (L.R.), University Hospital Zurich, Zurich, Switzerland
| | - G J E Rinkel
- From the Department of Neurology and Neurosurgery (R.K., B.S., E.K., Y.M.R., L.R., G.J.E.R., B.H.V.), Brain Center Rudolf Magnus
| | - B H Verweij
- From the Department of Neurology and Neurosurgery (R.K., B.S., E.K., Y.M.R., L.R., G.J.E.R., B.H.V.), Brain Center Rudolf Magnus
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Schermers B, van der Hage JA, Loo CE, Vrancken Peeters MTFD, Winter-Warnars HAO, van Duijnhoven F, Ten Haken B, Muller SH, Ruers TJM. Feasibility of magnetic marker localisation for non-palpable breast cancer. Breast 2017; 33:50-56. [PMID: 28282587 DOI: 10.1016/j.breast.2017.03.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 03/01/2017] [Accepted: 03/02/2017] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Accurate tumour localisation is essential for breast-conserving surgery of non-palpable tumours. Current localisation technologies are associated with disadvantages such as logistical challenges and migration issues (wire guided localisation) or legislative complexities and high administrative burden (radioactive localisation). We present MAgnetic MArker LOCalisation (MaMaLoc), a novel technology that aims to overcome these disadvantages using a magnetic marker and a magnetic detection probe. This feasibility study reports on the first experience with this new technology for breast cancer localisation. MATERIALS AND METHODS Fifteen patients with unifocal, non-palpable breast cancer were recruited. They received concurrent placement of the magnetic marker in addition to a radioactive iodine seed, which is standard of care in our clinic. In a subset of five patients, migration of the magnetic marker was studied. During surgery, a magnetic probe and gammaprobe were alternately used to localise the markers and guide surgery. The primary outcome parameter was successful transcutaneous identification of the magnetic marker. Additionally, data on radiologist and surgeon satisfaction were collected. RESULTS Magnetic marker placement was successful in all cases. Radiologists could easily adapt to the technology in the clinical workflow. Migration of the magnetic marker was negligible. The primary endpoint of the study was met with an identification rate of 100%. Both radiologists and surgeons reflected that the technology was intuitive to use and that it was comparable to radioactive iodine seed localisation. CONCLUSION Magnetic marker localisation for non-palpable breast cancer is feasible and safe, and may be a viable non-radioactive alternative to current localisation technologies.
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Affiliation(s)
- B Schermers
- The Netherlands Cancer Institute, Department of Surgery, The Netherlands; University of Twente, MIRA Institute, The Netherlands.
| | - J A van der Hage
- The Netherlands Cancer Institute, Department of Surgery, The Netherlands
| | - C E Loo
- The Netherlands Cancer Institute, Department of Radiology, Division of Diagnostic Oncology, The Netherlands
| | | | - H A O Winter-Warnars
- The Netherlands Cancer Institute, Department of Radiology, Division of Diagnostic Oncology, The Netherlands
| | - F van Duijnhoven
- The Netherlands Cancer Institute, Department of Surgery, The Netherlands
| | - B Ten Haken
- University of Twente, MIRA Institute, The Netherlands
| | - S H Muller
- The Netherlands Cancer Institute, Department of Clinical Physics, The Netherlands
| | - T J M Ruers
- The Netherlands Cancer Institute, Department of Surgery, The Netherlands; University of Twente, MIRA Institute, The Netherlands
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